Computer-aided position planning of miniplates to treat facial bone defects

RESEARCH ARTICLE Computer-aided position planning of miniplates to treat facial bone defects Jan Egger1,2‡*, Ju¨rgen Wallner3‡, Markus Gall1, Xiaojun Chen4, Katja Schwenzer- Zimmerer3, Knut Reinbacher3, Dieter Schmalstieg1 1 Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Graz, Austria, 2 BioTechMed-Graz, Graz, Austria, 3 Department of Oral & Maxillofacial Surgery, Medical University of Graz, Graz, Styria, Austria, 4 Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China ‡ These authors are joint first authors on this work. * egger@tugraz.at Abstract In this contribution, a software system for computer-aided position planning of miniplates to treat facial bone defects is proposed. The intra-operatively used bone plates have to be pas- sively adapted on the underlying bone contours for adequate bone fragment stabilization. However, this procedure can lead to frequent intra-operatively performed material readjust- ments especially in complex surgical cases. Our approach is able to fit a selection of com- mon implant models on the surgeon’s desired position in a 3D computer model. This happens with respect to the surrounding anatomical structures, always including the possi- bility of adjusting both the direction and the position of the used osteosynthesis material. By using the proposed software, surgeons are able to pre-plan the out coming implant in its form and morphology with the aid of a computer-visualized model within a few minutes. Fur- ther, the resulting model can be stored in STL file format, the commonly used format for 3D printing. Using this technology, surgeons are able to print the virtual generated implant, or create an individually designed bending tool. This method leads to adapted osteosynthesis materials according to the surrounding anatomy and requires further a minimum amount of money and time. Introduction The Reconstructions of facial deformations and defects due to bone fractures where two bone fragments are operatively stabilized, so called osteosynthesis, is part of a surgeon’s daily life. More precisely, these bone fractures occur as a result of applied outer forces, like happening due to traffic accidents, results of tumor removal or deformation treatment [1]. One major cause for facial fractures in regions where winter sports are frequently practiced is skiing and snowboarding [2]. These two sports account for most of the facial injuries overall, since wear- ing a helmet is not mandatory thus resulting in a high percentage of practitioners not equipped with appropriate protection like helmets, even though high velocities are reached not able to PLOS ONE | https://doi.org/10.1371/journal.pone.0182839 August 17, 2017 1 / 19 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Egger J, Wallner J, Gall M, Chen X, Schwenzer-Zimmerer K, Reinbacher K, et al. (2017) Computer-aided position planning of miniplates to treat facial bone defects. PLoS ONE 12(8): e0182839. https://doi.org/10.1371/journal. pone.0182839 Editor: Jose Manuel Garcia Aznar, University of Zaragoza, SPAIN Received: January 9, 2017 Accepted: July 25, 2017 Published: August 17, 2017 Copyright: © 2017 Egger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are uploaded to Figshare at URL: https://figshare.com/ articles/Cranial_Defect_Datasets/4659565; DOI: https://doi.org/10.6084/m9.figshare.4659565.v1. Funding: The work received funding from BioTechMed-Graz in Austria (“Hardware accelerated intelligent medical imaging”) and the 6th Call of the Initial Funding Program from the Research & Technology House (F&T-Haus) at the Graz University of Technology (PI: DDr. Jan Egger). Dr. Xiaojun Chen receives support by the Natural be absorbed by the skull in case of collision. According to Gassner et al. [3], the average age of people transferred to the department of oral and maxillofacial surgery with facial injuries lies by 26 years with 50% between age 16 and 38. The group with the highest rate of injuries is the one of children between 7 and 12 years. Further, there is a high variation between the groups of men and woman suffering from soft tissue damages or bone fractures in the facial area due to skiing accidents, stating that men account for 65.3% of the cases whereas females show a number of 34.7% injured patients. Moreover, the types of injuries range from facial bone frac- tures to dento-alveolar traumas and soft tissue injuries. There is also a wide range of different mechanisms including simple falls, collisions with others or objects, a struck by equipment, lift accidents and var

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